Ethical issues in mental health care

Nurses working in the care for psychiatric patients daily face dilemma’s concerning respect for autonomy versus paternalistic behavior. Questions arise about the use of coercion, e.g., when a patient doesn’t want to take his medicine, refuses treatment or suffers from delusions. Is coercion allowed only when there is a risk of damage to other people involved or also when only the patient himself runs a risk? In closed wards nurses contribute to decisions concerning the use of forced seclusion and separation of patients. Often their perspective on what is good for the patient differs from the psychiatrists’ view.

Another question is how to deal with relatives of persons with severe mental illnesses? They face a straining life situation and need support. Is this also a professional responsibility for nurses? Recent developments in European countries concerning cutting the costs of mental health care cause nurses to reduce care where they see that more care is needed. How can nurses deal with all these moral questions? Are they only the responsibility of the management, or do nurses have a professional responsibility? And is this professional responsibility mainly shown in following organizational rules and professional codes, or in personal professional virtues such as integrity, compassion and courage (Leijssen, 2000).

Landeweer, Abma & Widdershoven (2011) use elements from moral psychology to explain how moral judgments are developed through processes of interaction. They present moral case deliberation as a practical tool to systematically organize moral reflections among nurses on the work floor, aimed at learning to see different and new perspectives.

By Mariël Kanne/ University of Applied Sciences Utrecht